Major complications following total gastrectomy for gastric adenocarcinoma can triple the amount of standard hospital costs, according to research published in JAMA Surgery (published online June 28, 2017; doi:10.1001/jamasurg.2017.1718).
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Prior studies have consistently shown that surgical complications—especially in gastric adenocarcinoma—increase postoperative costs. However, these studies have failed to fully identify the components of hospital care that drives these high costs.
Luke V Selby, MD, MS, department of surgery, Memorial Sloan Kettering Cancer Center (New York, NY), and colleagues conducted a retrospective analysis of their previous study to describe the association between postoperative complications with hospital costs and to identify specific drivers of the cost differences between patients following total gastrectomy. A total of 120 patients were sampled who underwent curative-intent total gastrectomy from stage I-III gastric adenocarcinoma between 2009 and 2012. The main measurement was 90-day normalized postoperative costs.
Results of the analysis indicated that most instances of increased hospital costs were directly related to attempts to correct morbidity and prevent mortality.
Among the 51 patients (42.5%) who underwent uncomplicated total gastrectomy, mean normalized cost of Medicare proportional dollars was calculated at $12,330 (standard deviation, $2500), predominantly owing to the cost of surgical care (mean cost, $6830; standard deviation, $1600).
Among the 34 patients (28.3%) who had a major complication, mean normalized cost of Medicare proportional dollars was calculated at $37,700 (standard deviation, $28,090). While surgical care was more expensive in these patients (mean cost, $8970; standard deviation, $2750), the procedure only accounted for 24% of the total cost. The remaining cost drivers included room and board (mean cost, $11,940; standard deviation, $8820), consultations (mean cost, $3530; standard deviation, $2410), and intensive care unit care (mean cost, $7770; standard deviation, $14,310).
Researchers concluded that most of the excess hospital costs after total gastrectomy for gastric adenocarcinoma were related to the treatment of complications. “Interventions that decrease the number or severity of postoperative complications could result in substantial cost savings,” they wrote.—Zachary Bessette
